<div class="inner_pop user_info_pop">
    <div class="user_form">
        <p class="fs33">恭喜你上传成功！</p>
        <p class="fs21">完善你的基本信息， 就能申请安满免费试用装哦！</p>
        <form action="">
            <table border="0" cellpadding="0" cellspacing="0">
                <tr>
                    <th><label for="name">姓名</label></th>
                    <td>
                        <div class="f_list">
                            <input type="text" id="name" class="ipt req" value="请填写您的真实姓名"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <th><label for="tel">手机</label></th>
                    <td>
                        <div class="f_list">
                            <input type="text" id="tel" class="ipt req ipt_346" value="请正确填写，以便工作人员可以和您联系派送事宜"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <th>城市</th>
                    <td>
                        <div class="f_list">
                            <div class="province fl">
                                <select name="province" id="province" class="select">
                                    <option value="选择省份">选择省份</option>
                                </select>
                                <span class="forge_select  forge_select_168"><span class="innertext">选择省份</span></span>
                            </div>
                            <div class="city  fr">
                                <select name="province" id="city" class="select">
                                    <option value="选择城市">选择城市</option>
                                </select>
                                <span class="forge_select  forge_select_168"><span class="innertext">选择城市</span></span>
                            </div>
                        </div>
                    </td>
                </tr>
                <tr>
                    <th><label for="address">收货地址</label></th>
                    <td>
                        <div class="f_list">
                            <input type="text" id="address" class="ipt req" value="请正确填写您的地址"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td colspan="2" class="tac">
                        <div class="f_list">
                            <input type="submit" id="submit_userInfo"/>
                        </div>
                    </td>
                </tr>
            </table>
        </form>
    </div>
    <div class="close m_close"></div>
</div>
<script type="text/javascript" src="js/user_form.js"></script>